Wiki E/M Same Day as PAP

[mmagness]

Is is common for a insurance company to deny a Pap smear as "included" in the E/M service done on the same day?
Example: Patient came in for a PAP and while here mentioned that she had some congestion and sinus drainage. We billed a E/M service for the head congestion etc and also billed for the PAP- but insurance denied. Does anyone have any suggestions on how to (if we can) get both services paid?

Any help is appreciated.

Thanks,

Molly

 

[Lisa Bledsoe]

What CPT are you using for the pap? The pap codes in the laboratory section of CPT are not billable by the physician office, only pathology/lab.

 

[halebill]

So......it should add to the overall E/M charge?

 

[Lisa Bledsoe]

If the "pap" is actually her annual physical, it should be billed as preventive and the problem oriented portion of the visit should be billed as an e/m with mod -25.

 

[mmagness]

We billed a G0101 for the Pap and a 99213 (25) for the office visit and they denied...

Thanks,

Michelle

 

[cheermom68]

G0101

G0101 is actually a Medicare code. Some insurances will accept and some won't, this might be one that doesn't accept this code and includes the service in the E&M for the day.